Healthcare Provider Details

I. General information

NPI: 1609637115
Provider Name (Legal Business Name): HEATHER ROWLEY RD LD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 AVERY RANCH WAY
JUSTIN TX
76247-6653
US

IV. Provider business mailing address

9330 AVERY RANCH WAY
JUSTIN TX
76247-6653
US

V. Phone/Fax

Practice location:
  • Phone: 817-727-9652
  • Fax: 940-828-1460
Mailing address:
  • Phone: 817-727-9652
  • Fax: 940-828-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ROWLEY
Title or Position: OWNER
Credential: RD
Phone: 817-727-9652